Nursing is fully aware of consent. We know that we need to have documentation that the patient accepts this treatment. It’s a no brainer. But, what if the patient doesn’t want treatment and the power of attorney does?
Prime example, you have an elderly patient that is obviously letting the family talk them into surgery. To no one’s surprise, it doesn’t go well. They end up sick. They have to remain intubated. They need an art line, central line, pressors, the works. Even on the ventilator they are adamantly shaking their head no to all the things you’re trying to do. They are fighting. They keep trying to pull away. They don’t want this.
Their family does.
The POA is who the doctors decide to ask for consent to treat. They completely bypass the patient. They’re intubated, they can’t answer for themselves right? If course the family wants everything done… So, everything is done. Is that fair to the patient?
Shouldn’t the patient be allowed to say no without having someone else choose otherwise? What is the fine line that decides when a patient no longer has the capacity to make their own decisions? Does intubation automatically take away that right? Does having a POA take away that right? If a patient is clearly communicating, even in the vent, shouldn’t we respect their wishes?
The nurse in me says yes. The nurse in me says to respect my patient’s dignity.
The nurse that’s been at the bedside for almost 8 years knows that that is normally not the case.
I have seen advanced directives ignored because the patient is unconscious and the family isn’t ready to let go. I’ve seen cases like the one mentioned above. I’ve seen doctors watch as the family is almost forcing a patient to go along with treatment and the doc just goes along with it as well. I’ve had to be a part of “moral distress” meetings because nurses were stressed over the ethical dilemmas involved in certain cases. When do we stop?
Barely Sane Nurse 
I can’t imagine what a difficult situation this would be to a health care professional.
Your post really struck a chord with me. It’s nurses like you who make all the difference to families during difficult times. Even though you may not be sharing with them the thoughts you described in your post, they know you care about the quality of treatment and that you want things to get better. Thank you for that.
LikeLike
Oh gosh! Does the patient have capacity to make the decisions? That’s such a tough one. Sometimes you have to act as an advocate for your patient though 😔 it’s sad.
LikeLiked by 2 people
Sometimes when a patient is intubated the team will begin to act as if they don’t have capacity. That’s when we try and step in.
LikeLiked by 2 people
That’s good then 🙂 I think you guys do everything differently to us maybe? It depends on the situation. We have a few things in place so that the staff can over rule these things if they thought it was best interest of the patient. It can be a long process though!
LikeLiked by 2 people
Fear is a powerful emotion.
LikeLiked by 1 person
Fear really changes a lot of things
LikeLiked by 2 people